00100134 (2) CITY,OF CUPERTINO -` -
nITILI) c.V1VISION 'PERMIT;.1 CONTRACTOR'INFORMATION:
BUILDINGADDRESS'.• " PERMIT NO..
ET
.OWNER'S A ;. - -BUDGET. - - AppLicAiZZABli
l
IiON6. _ - SANITARY ,NO.
deQC ARCHITRCTIENGINEER: - fy - BUILDING PERMITINFO ••
BI'DO ELECT 'PLUMB. MLC I „
I ICENSI D CONTRACTORS DFCI ARAI ION -' ,106 Del(,PI nOn '
pz O II b) ff nth 11 lie .elu I p fCl opt 9( , ng e p
F t u� wnh Seclon]B00)afD .a3 fficBu d Professions Codcvnd mylcc,w e.
Y
..]] s'nfull f e ,dell t
���jUP Da . Cla.' L k.
Se 3 Dire c poplar k - '
oa ARCHITECTSDECLARAIION WATER,HEATER_ REPLACEMENT
1 d .t J ypf hill 6. d publicb +'
Licensed Professional
�' i •OWNER BUII'DFII+DI CLARATION
U— I h byfora t l script f theC ma
¢, L' I nw for the
d Ind. y (Soft ]031.5 Bu,ini and P f" .Code A Y oil, county + ,,
F C wGap 4 p i t[ constrict.ally p� demolish, r pe y structure
, ac,m p-o t is I. ,rare.the ppl tf '. a p nto 11 ;e d n d,n •'r
Innen . rip rI m pm : rte c nt eI aI L (cl pla9 S Ft:Floor Area', Valuation '
t (ammenc'g wlh Semon 9000)of Division 3 of the Env'oen and Professions Code) q' _
ml Ih pith rn t add the hs 1 Il alleged e pt Any violation
r ofS t 7031,5by air,Appl t ban isphics,the a,licippoot,,illi penalty
of,t m, t handled I ll (s500) p - ' APN Number +
Occup$ c6 pe
W .1, nn o P nY Y pl v 0 {' , ,
will d N k d 111 structure Iintended g off ed f (S (14
] 0 n , ems.
Bus' J Pr ,f Code TheC t I License L d ,apply t o Required'Inspections
,,,act limper,Who n la imprava,W an n,it who d es inch wok ninser 34212087. Qt.
o er for
ti., employee,,he 'dad(Iranand,' p - 1' rte dal of .. a ' .
offered for sale If however,the building NardimprovementprApa sold within nae year of -
ampl0 ,, th er-n II 1l have Nenunlennrpravn,garli Ilnor.mild or'
ap'now,f. p}p_ po ' )
- 5b^ - FINALE. PLUMBING ENERGY ,
°1, r fm ptty I ly contracting 'the dimperiousi 5GG- GAS TST'
oast tth project(Sec.90448and f.. - Cd )TIeCt t
construct
imnela J t apply to an fp property n hl improves 507FINAL:PLUMBING
o
'
, ¢
and In.emanon l¢wch pmdran w ih ane ,,tractor(,) a nse4 puoonm to the - _ --
Conimcmr'nliccnsc Law. - - +�
.El I alp exempt under Sea ,B&PCfid r that.Wren on1 ' �'-
Caper ., "'Rote - - -
'l WORKERS COMPENSATION.DGCCARAT10 - -
I hereby affirm underpenally q perlpp oneof the fall t y de F utintAA.
t
}'
❑ Iia' and wlll'nn titin v Certificate of Cement n, x If' for Wiirk 's n
Compensation, os provided her by Section,3900 of the Lahur Cade, for the
performance nhthe work for which this permit is issued.
I '
°I have and will ten ow' W k C np a I o req J by Section
`
' 3900 of the Lahor Code,fill the performance of the work lar which this pe n it is
store My Waker s Coarlwasatimplnwran' tier and Polf)numberate
.Carter. ^• Policy bon, I , y
CERTIFICATION Or EXEMPTION FROM WORKERS'
., COMPENSATION INSURANCE
(Thi,_xection need nor be d iiplided if the permit is far.,at hundred dollars
($mop or c,o) '
I certify that',,llfic:,arfpfth :far which'h.d I is oped,1
shall not employ any person in any manner was un ha nine bjtat I.(lie rks: y
Compensation Laws of California one •n„ - }^' - ,
Applicant
NO I ICL TO APPLICANT if.after makingth Certificate of Exapplion,yen.h Id
hcco n tt II,W k C , t np raeLbrC y test ^) 1
C fnrthw'th co npl)w'h x p or In,permit sM1 ll be d •teed revoked • - -
z 'cions _ A }
E 4 CONSTRUCTION LENDING AGENCY •
E
I be by affirm that(here isoconstructionring age,,I fortlicpart omiana, ,
of One k for which thispermit ,hoped(See 3097Cb,Cb
Q Lmidrs Name .• ; 1
Lmider Aldee,
1 certifythtIhave
d firs applicationand law fint,freambee ionfidfiprfi - -
0 V antes I d brac In IIy with all city and altralty aadjunifices and spoilt...datingi. iw -
to tit Id'geonslmevbn Jh b)aulh 1 p e tori enllh': lymcnerupon
am aM1 n I Ip tyl n.P 'f 1 P e_ +
G�
P.
Meantime firdeandify fitweph le:the Cry fC p n g :1'
V) - liabilities,judgtoems,costsd expenses o.h h ay in any way a against mid:
U ti City m
comegn,cof to g fag of mi,p rmnt - it " -
APPLICANT UNDERSTANDS AND,WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS Issued by: Dal -
j'
,., Sigmms of ApplieantlCannaemr, !' 'Datcy'p J_' Re-roofs • •„• xl -
HAZARDOUS MATERIALS DISCLOSURE
w'utife applicant or future building, p t store n or Dan .ro .materia . Type of Roof. _ill
as refired by 1110 Cupertino Mn n.efpal Cod CI pt 9,12 and IA I I 1tl and Safety
.Code Sec0,n 25532(x) -, -
El Yes
°N, All roofs shall be inspe&edtprior to any roofing material being installed.• -
W"II m it t triple as holding lin to ydp t l e, ehick' If a,roof is installed without first obtaining an inspection,I agree to remove
emlll -Ron,reams ams ox dcC uA by the Bay ArciA rQual Quality Mun:ganm
Di tripa all new materials for inspection. Applicant understands and will cote 1 with
❑Ye, Cl Non t-, ,� p» PP PY”
all non-point source regulations'. .
1 have read the h art materials mgr rements mai Ch liter 6.95 of the '
Califo ',Nevem&S C ry C 1 Section, 550 25539 d 25534,I dominant ItI N
Ethel 'Id'pKd note eOYh r tthtit'. 'hl'tYt really the .. a
9c
of cup t f therequirements which must b t p to naso,ace t a Certificate of -x 'G
ouapa,bv' 1 I' ,a,Signature of'Applican[ Date
Owns th reed agent .Date All roof coverings to tie Class"B"or better `
Ut
y